Provider First Line Business Practice Location Address:
314 W KINGS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27288-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-623-1901
Provider Business Practice Location Address Fax Number:
336-623-5144
Provider Enumeration Date:
12/27/2006